JCPSLP Vol 23 No 3

Discussion This research builds on previous work examining the use of telesupervision by examining clinical educators’ experiences of providing telesupervision during a simulation placement, and how the online modality shaped their supervision practices. Previous literature has situated both telesupervision and simulation as creative responses to a lack of traditional placement opportunities (MacBean et al., 2013; Nagarajan et al., 2018), and/or as a beneficial adjunct to face-to-face supervision (Chipchase et al., 2014). The findings of this research challenge us to consider telesupervision not as supplementary, or “second-best” but rather as an opportunity to increase the quality of clinical education, variety of clinical expertise and experiences and demonstrated the efficacy of telehealth clinics in speech pathology management of stuttering (McGill et al., 2019). In addition, positive student learning experiences during stuttering clinics using a range of modalities have been established including: an intensive face-to-face stuttering clinic for adolescents and adults (Cardell et al., 2013), a combined telehealth and face-to-face stuttering clinic (Bridgeman et al., 2018), and face-to-face simulation- based learning program (Penman et al., 2021a). This research further builds the evidence-base regarding student development of stuttering competencies, focussing on the experiences of clinical educators within a telepractice stuttering clinic for students. The clinical educator participants in this research experienced telesupervision as a learning experience, with successful transition to online supervision underpinned by an openness to learning, well-developed problem- solving skills, a strong capacity for self-reflection and peer support. Through participation in the simulated telepractice placement participants developed both telesupervision and telepractice clinical practice capability, with some participants learning new telepractice strategies from students. Transition to telesupervision required clinical educators to develop and adapt their clinical, teaching, and interpersonal skills for the online environment, mirroring students’ own transition to telepractice clinical education (Overby & Baft-Neff, 2017). Successful transition to telesupervision demanded CE flexibility, including an ability to quickly develop new ways to meet student learning needs in an online simulated clinical environment. These cyclical problem-solving skills (Chipchase et al., 2014) are key to ensuring quality and responsivity to student needs (Nagarajan et al., 2018). The simulated nature of this placement decreased pressure on CEs as any student mistakes would not impact real client well-being. This facilitated CEs’ ability to reflect on their supervisory practices, problem solve and adjust their practices in real time, reflecting findings regarding student learning in simulation (Harder, 2010). As telesupervision was a new experience for all CEs involved in the research, participants were learning how to facilitate student learning in an online simulated placement through doing and importantly reflecting on and in their actions. This is consistent with Schön’s (1983, 1987) widely accepted approach to professional learning in health professions where professional knowledge is developed by reflection on and in practice experiences. In addition to learning through individual reflection, this research has highlighted the importance of collaborative reflection on supervision practices through peer support from other increase capacity for being student-centred. As discussed above, previous literature has

CEs as participants adapted to online supervision. This finding resonates with Brookfield’s (1995) and Barnett’s (1997) argument that knowledge is socially constructed and sustained and that critical thinking incorporating social processes is central to the development of professional knowledge. The simulated telepractice placement also offered a flexible approach to clinical supervision that was highly valued by the participants. This flexibility enabled the CEs to better maintain paid work commitments and other responsibilities and reduced costs associated with travel to a face-to-face placement. The flexible nature of the simulated telepractice placement also opens opportunities for CEs from any location to be involved in future clinics. However, the sustainability of telesupervision also needs to be considered from a time and cost perspective. Participants reported a need for an increased educator- to-student ratio to meet student learning needs in the online space, while also identifying the additional time commitment required for telesupervision. These factors were also identified by Nagarajan et al. (2016, p. 25) who described “workload implications” and “concerns about the time–cost benefit” as key barriers to the success of a telesupervised placement. While this clinic represents innovation from ‘those on the ground” and provides continuing opportunity for strategic innovation (Howes, 2018), ongoing support from university management is needed to cover the cost of additional clinical educators’ hours as well as appropriate clinical education, telepractice, and simulation infrastructure, knowledge and skills (McCormack et al., 2014). Clinical educators’ supervisory practices were significantly shaped by the online mode of this simulated telepractice placement. The participants described a strong need to explicitly focus on supervisory practices that are often taken-for-granted during face-to-face placements and simulated clinics. While the clinic was unique in both its online and weekly (rather than intensive) formats, the educators identified the online mode as the significant factor influencing relationships. As an example, clinical educator–student relationships that often evolve spontaneously during face-to-face simulated and real placements, required deliberate attention with the participants acknowledging that relationship development online could be difficult and motivating student engagement challenging. The participants deliberately constructed virtual spaces such as break-out rooms to facilitate interaction between students and clinical educators as well as peer-to- peer interactions between students. Reflecting Nagarajan et al. (2018)’s recommendations regarding ethical telesupervision, the online environment required CEs to remember to take students into break-out rooms to provide confidential feedback as opposed to taking advantage of serendipitous moments such as walking between patients or handwashing that occur during face-to-face placements. The importance of opportunities for peer-to-peer support between students on placements to enhance learning through trading stories, answering questions, and providing reassurance has been established (Patton et al., 2018) but has not previously been described for virtual simulated placements. Limitations This research has demonstrated the potential of telesupervision as a clinical education modality in a telepractice stuttering simulated placement from the

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JCPSLP Volume 23, Number 3 2021

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